Imagine waking up not remembering where you are or how you got there. Imagine not recognizing your own family. This frustration is not just a hypothetical, but a reality for many patients with Dementia. According to a recent study, 3Dementia is “characterized by a progressive decline in cognitive and physical functions, and patients often present behavioral problems. Cognitive functions affected by dementia typically include memory, global cognition, attention, and executive functions.”2 Many types of Dementia, including, Lewy Body’s Dementia and Vascular Dementia, along with general frontotemporal degeneration, are caused by Alzheimer’s disease.1 Alzheimer’s disease occurs when there is a presence of an abnormal protein in the brain, known as plaque. Alzheimer’s disease causes the brain to atrophy, which directly effects cognitive and motor function.1 Dementia is both a chemical and physical change in the brain. Along with direct consequences that effect the individual with Dementia, family and loved ones are often affected by the effects of this devastating syndrome. According to the Mayo Clinic, Dementia “affects immediate family, turning spouses or children into caregivers and often straining family finances.”1 Unfortunately, there are no quick fixes for this degenerative syndrome. Although this is the case, science has proven that exercise can help reduce the symptoms of dementia.4 With this foundation, what specific types of exercise help reduce symptoms physically and neurologically? Another question to explore is, what types of exercise help reduce the degeneration of symptoms without agitating the individuals with Dementia?
Exercise has been shown to influence the physical function of individuals with Dementia. According to a recent study conducted to observe the experiences of elderly people with Dementia in a high intensity functional exercise program, exercise has notably shown a significant positive impact on walking performance, balance and activities of daily living in those individuals with Dementia.4 If an individual who is declining, both cognitively and physically, is able to increase their physical well-being, they will be able to become more active and independent. This independence may cause them to have a better sense of purpose and confidence within their personal lives. With the knowledge of exercise’s benefits on physical function, can people without Dementia use exercise to prevent the syndrome? According to a recent research study, the incident of dementia was 13 per every 1000 people per year for individuals who exercised three or more times per week. For individuals who exercised less than three times per week, the rate of dementia was 19.7 per every 1000 people.3 With this information, it is clear to see that exercise is important for individuals who want to prevent Dementia and individuals with Dementia who want to improve their quality of life.
Exercise has been shown to positively influence the neurological symptoms of Dementia. As Dementia develops in a person, and neurodegeneration occurs, specific proteins begin to build up in the brain, causing a plaque cumulation.1 As previously stated, research has shown no direct medication to be effective in the breakdown of these proteins.1 Although this is the case, research has shown that long-term exercise plans have proven to benefit cognition, dementia risk, and progression.1 Recent studies have shown that this cognitive change can be backed up through analysis of brain function. It has been found that a long-term aerobic exercise plan showed to significantly improve hippocampal, or memory, function in elderly adults.4 Unfortunately, exercise did not show to have an improvement on cerebral blood flow in individuals who exercised regularly,5 although studies have found that individuals with Dementia, who stuck to an exercise routine, had an improved preservation in grey matter compared to individuals who did not exercise regularly.1 The preservation of grey matter is important because without it, the brain would not be able to properly function. This information also suggests that exercise can help slow down atrophy of the brain. If simple aerobic exercise, such as walking can help elderly individuals significantly improve memory function and brain volume preservation, exercise can be seen as an extremely important tool to be utilized in fighting the symptoms of Dementia.
Types of exercise are important, as to not solicit anger or frustration in patients with Dementia. Many Dementia patients show true frustration when performing a task that is difficult. It is easy to empathize with these individuals, knowing that they used to be able to complete simple tasks with greater ease. If clinicians are to prescribe exercise as a way to reduce Dementia symptoms, the type of exercises suggested must be chosen carefully, as to not solicit frustration in the patient. The characteristics for exercises that do not solicit frustration are ones that are task specific and progress to a high intensity.4 It would not seem as though high intensity exercises would solicit a more positive behavior, but research suggests otherwise. A recent study observed individuals over the age of 65 who had Dementia. These individuals were asked to attend a long-term exercise program that focused on activities of daily living, such as squatting, stair climbing and maneuvering around different obstacles. These activities were performed at a high intensity and focused on pushing the individuals who participated. The research team reported that many of the participants described their regiment as “nice” and “fun,” among other joyful terms.4 One participant described how well they felt because of all of the blood flow activity that had become unfamiliar to them.4 Since the exercises were specific and progressed to a high intensity, the participants did not mind the activity. Another study wanted to determine whether the exercises performed by individuals with Dementia had to be more aerobic or anaerobic in nature to cause cognitive benefit. The study observed two groups; one group performed aerobic exercise for a year and the other group performed anaerobic exercise for a year. The study concluded by stating that the individuals who performed the aerobic activity had a significant increase in hippocampal activity, compared to those who performed the anaerobic activity.1 Through this, science has shown the world that in order for an individual with Dementia to conform to an exercise pattern, and have it benefit them, the exercise must be aerobic in nature, specific in task, and increase to a high intensity.
In the world of Physical Therapy, exercise is the main success tool used to help a patient achieve positive results. A good clinician will not only treat the symptoms of an individual but use clinical judgement and reasoning to treat the whole person. In the case of individuals with Dementia, it is important that the Physical Therapist or Physical Therapist Assistant knows how to best treat the individual. If the patient presents as angry or frustrated, the clinician must try to understand where the patient is coming from and make the best clinical judgment as to the type of exercises performed that treatment session. With the knowledge provided on the correlation between types of exercise and Dementia, clinicians can utilize this and better treat their patients. If a patient with Dementia presents with lower extremity weakness, the clinician may be inclined to take a walk with the individual before utilizing strength training and basic movements. Although strength training may seem to be the quickest way to restore weak muscles, the clinician must remember to treat the whole person and not just the symptoms present.
Dementia is a neurologically degenerative disease that not only effects the physical and psychological aspects of a person, but the social and economic aspects, as well. It creates tension in families and puts unwanted stress and frustration on loved ones. Although there is no cure for this horrific syndrome, there are ways we can prevent the onset of symptoms, as well as reduce existing symptoms. Through research, physical activity has been shown to help reduce the symptoms of dementia. Exercise has also been shown to help with the prevention of dementia. Research suggests that the exercises that provide the greatest effects are ones that are physically challenging, aerobic in nature, task oriented, and long in duration. This type of exercise helps individuals with Dementia to improve within their activities of daily living by increasing coordination and strength. This type of exercise also helps these individuals improve their memory function, as well as preserve their grey matter volume. Exercise has shown itself to be extremely crucial for the global health of an individual. Encouraging an individual to exercise, as well as pushing yourself to exercise, may be the difference between good health and poor health. If clinicians are able to educate their patients on the benefits of exercise, a patient’s future health will be improved.